This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, January 22, 2011

Weekly Overseas Health IT Links - 21 January, 2011.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

WASHINGTON, Jan. 13 (UPI) -- Eighty-one percent of U.S. hospitals and 41 percent of physicians say they want to use federal funds to use electronic health records, surveys indicate.

The surveys were commissioned by Office of the National Coordinator for Health Information Technology and carried out in the course of regular annual surveillance by the American Hospital Association and the National Center for Health Statistics, part of the Centers for Disease Control and Prevention in Atlanta.

Dr. David Blumenthal of the National Coordinator for Health Information Technology says the survey numbers represent a reversal of the low interest in recent years in electronic medical records adoption -- attributed mainly to the cost and time needed to set up a health technology system. If there are high rates of adoption, about $27 billion in incentive payments would be allocated during a 10-year period, Blumenthal says.

The U.S. market for inpatient and outpatient electronic health records software was nearly $1.98 billion in 2009 and will steadily increase to $3.8 billion in 2015, according to a new report from research firm IDC Health Insights, Framingham, Mass.

For purposes of the market survey, the figures cover only software license and maintenance costs for products that meet or exceed meaningful use certification criteria.

University Medical Center in Tucson, Ariz., has announced the firing of three employees for improperly accessing electronic health records of victims of the shooting spree on Jan. 8. A contracted nurse also was fired by the nurse's employer.

The federal Health Information Technology Policy Committee is seeking public comment on its proposed Stage 2 meaningful-use recommendations for electronic health-record system subsidies under the American Recovery and Reinvestment Act of 2009.

A 19-page set of instructions (PDF) for individuals and organizations seeking to submit comments is posted on HHS' website. Included in the instructions are the committee's draft recommendations.

The leadsman's cry, "By the mark, twain," signaled a depth of two fathoms. It meant there was sufficient water running beneath the riverboat, but not so much that it couldn't soon run aground. (It also inspired a famous author's pen name.)

A similar cry, I think, went up Tuesday from healthcare providers, most of whom are early adopters of health information technology systems.

They told members of a federal advisory work group that they and their provider organizations were paddle-wheeling ahead, following the course piloted for them by the federal electronic health-record subsidy program. But most shared their anxieties, too.

Earlier this month, the Office of the National Coordinator for Health IT released a final rule to establish the permanent certification program for health IT. The rule did not include any big surprises, something stakeholders say they are pleased about.

"Everybody worries about a big surprise, and there really weren't any," Karen Bell, chair of the Certification Commission for Health IT, said, adding, "Most of the rule is actually very procedural."

The Health IT Paradox: Why More Data Doesn't Always Mean Better Care

Recently, while I was working an overnight shift in the emergency department, two paramedics wheeled an elderly woman into the busy ER. She was clearly very ill: her eyes were sunken and her mouth was parched, she was slumped over and unable to do much more than moan. The paramedics told me that her family members, who had stayed home (not uncommon!), wanted to make sure we knew that she wasn't usually "like this" and that she had recently been hospitalized at a different facility where many tests and "other stuff" had been done. Unfortunately, all her records were locked up at the other hospital's medical-record room, which was closed in the middle of the night.

We had to start from scratch. We ordered a CAT scan of her brain to look for stroke, put a catheter in her bladder and gave her a chest X-ray to look for infection, and applied a rectal exam to look for bleeding. We may have ended up doing all of this anyway, but having more information about her recent hospitalization would clearly have allowed us to be more efficient and directed in her care. My colleague, another doctor, turned to me and said, "I cannot wait until HIT [industry shorthand for 'health-information technology'] makes this problem goes away."

The "problem," of course, is that medical errors and excess costs increase when health information isn't portable or easily accessible. The conventional wisdom is that electronic medical records, electronic prescriptions and electronic order-entry systems save costs and lives. Since 2009, the federal government has invested over $20 billion into improving HIT. And this month, the federal government will start doling out dollars to doctors' offices and hospitals to encourage them to adopt electronic health records. On its face, this makes absolute sense — who, after all, would argue that more information isn't essential to improved care at lower cost? During the last presidential campaign, both Senators John McCain and Barack Obama called for HIT enhancements as key to fixing health care.

Medical images should have a role in the next stage of meaningful use of electronic health records because of the wide use of radiologic and other images in diagnosis and treatment in healthcare, according to health IT experts.

Dr. David Blumenthal, the national health IT coordinator, gave support to considering the concept at the advisory Health IT Standards Committee meeting Jan. 12, saying “the role of imaging as a meaningful use aspect raises a number of important and interesting questions that I think we will be looking at tackling.”

Clinician access to images, such as timed serial images of portions of the heart, is increasing with the capabilities of electronic and tele-health systems and mobile technologies, said Dr. Robert Pettigrew, director of the National Institute of Biomedical Imaging and Bioengineering in the National Institutes of Health.

Establishment of a "pharmacy home" model, similar to a medical home model, could better coordinate medication therapies for chronically ill patients with many prescriptions, according to a study published Jan. 10 in the Archives of Internal Medicine.

Provider organizations, according to authors, need to find ways to help patients simplify, synchronize, centralize and organize their medication management. There is a particular need to synchronize medication regimens because "those who make numerous trips to the pharmacy to pick up their medications, or fill prescriptions at different pharmacies, may have difficulty taking their medications as prescribed," the report contends. Report authors also recommend experimenting with programs and technologies to make it easier for patients to better organize their medications.

The Rochester (N.Y) Institute of Technology and the University of Rochester have created a two-year, 14-course master's degree program in healthcare informatics, according to a news release from the schools.

Classes will begin in September, with a target initial enrollment of 12 students, according to RIT spokesman John Follaco.

HealthLeaders Media Staff , January 14, 2011

Healthcare physician leaders and executives mostly support the national initiative to implement electronic health systems, and say they will improve efficiency and quality. But they're also uneasy about the cost, value, and functionality of their own systems, a new HealthLeaders Media Intelligence analysis has found.

A survey of 242 healthcare leaders from hospitals, physician groups, and health plans, detailed in the latest HealthLeaders Media Intelligence Report, E-Health Systems: Opportunities and Obstacles, found that more than 80% of healthcare leaders say the government's push for electronic health systems will improve quality of care industry-wide, and 89% say it will improve quality and safety at their own organizations.

That confidence cools considerably when it comes to the capabilities of their systems. Only about half of hospital and health system leaders are either very satisfied (13%) or somewhat satisfied (41%) with the overall functionalities of their systems. Among physician leaders, the numbers are similar: 16% are strongly satisfied and 44% are somewhat satisfied.

The dreaded MRSA infection has one enemy your infection control officer might not have thought of: Your hospital's EMR.

In an article in the November issue of the Journal of Antimicrobial Chemotherapy, researchers report that when staff have access to an EMR, they are more likely to review charts and recommend the infection control measures. The result: MRSA infections at two North Carolina hospitals--East Carolina University and Pitt County Memorial Hospital--fell by 45 percent, and nosocomial infections from clostridium dropped 19 percent. The study reviewed infection rates from January 2005 through December 2009.

Training staff on IT security will be a key component for protecting your electronic health record integrity in 2011, according to a new Kroll survey on the top data security trends for 2011. Most important: Privacy awareness training for all employees, from the c-suite down to the janitorial staff, Brian Lapidus, Kroll's COO tells FierceEMR. "It's really a mantra [at Kroll]--privacy awareness training is the cornerstone of any data security program," he says.

Think it's not a top priority? As part of its work for HIMSS Security of Patient Data report, Kroll surveyed healthcare providers who had experienced a breach. Nearly 80 percent said the first task they had to undertake was additional staff security training. And staff training is increasingly being required in the voluntary compliance plans hospitals have to create after a breach, so you know it's something regulators want.

PITTSBURGH – When it comes to exchanging patient data with other healthcare providers under the Stages 2 and 3 meaningful use criteria, the University of Pittsburgh Medical Center (UPMC) will be able to create a unified and connected patient record.

UPMC has been offering multiple ways for affiliated physicians - no matter their level of health IT capability - to connect to the integrated delivery network. An important next stage of its affiliated integration, as well as its own internal electronic medical record, is to enable a Continuity of Care Document (CCD) exchange with physicians who move their patients in and out of the system, according to Lisa Khorey, vice president of enterprise systems and data management.

As primary care physicians (PCPs) refer their patients to UPMC employed specialists, the CCD from the physicians' EMR should come with the patient or with the consult, she said. As patients move through UPMC's program - whether it be transplant, cancer care, pediatric emergency department visit, or other area - the CCD should accompany the patient directly to the next provider of care as part of the transition. "That's an important part of connecting the affiliate community for us," Khorey said.

No less a tech guru than the WSJ’s own Walt Mossberg has challenged the tech world to come up with devices that make it easier for consumers to track and manage their health. Now a new survey looks at what health-management technologies caregivers are most interested in.

The survey, released over the weekend by the National Alliance for Caregiving and UnitedHealthcare at the Consumer Electronics Show’s Silvers Summit, identifies three technologies that seemed to have the most appeal. More than half of the 1,000 people surveyed — all of whom have already used some form of tech to help out with caregiving — said none of the usual barriers, such as cost or privacy worries, would stop them from trying the following (things).

Age demographics of doctors and financial assistance to help them adopt the technology are responsible for the transition, analysts say.

For the first time, a majority of office-based physicians are using an electronic medical records system, according to a survey by the Centers for Disease Control and Prevention's National Center for Health Statistics.

The survey doesn't explain why EMR use in offices rose to 50.7% in 2010, more than double the adoption rate in 2005. However, peer pressure is apparently moving from fighting EMRs to embracing them. "We're in an electronic age. You either go with it, or you're in the Dark Ages," said Pat Willis, RN, chief nursing officer for seven-physician Big Sandy Healthcare, in eastern Kentucky, which installed its first EMR in July.

The Office of the National Coordinator for Health IT is developing an online, interactive dashboard that will continuously track the performance of regional health IT extension centers and allow for the timely sharing of lessons learned.

A first-look “static” version of that progress summary should be available by the end of January, according to Mat Kendall, director of ONC’s Office of Provider Adoption and Support.

The 62 centers, spread across the US, offer a variety of services, including education, vendor selection and project management, to help health providers establish and become meaningful users of electronic health records (EHRs) and to help them redesign their workflow.

Physicians from group practices with extensive experience adopting and using electronic health-record systems testified before a federally chartered advisory group Tuesday.

The elite EHR users—who self-defined their groups in terms of EHR implementation to be in the upper 25% of all EHR users nationwide—said that meeting the Stage 1 meaningful-use criteria to receive federal EHR incentive payments presents multiple challenges to their practices.

They also warned federal rulemakers against setting the bar too high when second and third stages of the meaningful-use requirements are set for 2013 and 2015.

On Dec. 30, 2010, the Obama administration launched Physician Compare, a website that will eventually include data gleaned from the Medicare meaningful use incentive program and that has the potential to dramatically change the way Americans choose their doctors.

Imagine comparison shopping for a doctor based on patient reviews, a set of easily comprehended measures of quality and other criteria. It's one of the Holy Grails of a truly patient-centered system!

The health reform law required HHS to launch the site by Jan 1. For now, it's mainly an updated directory of doctors and other health care providers nationwide -- 932,000 in all -- who accept Medicare beneficiaries. It's searchable by ZIP code, city, state and medical specialty. Doctors who are participating in Medicare's Physician Quality Reporting System have a mention of that in their profile. Those participating in Medicare's electronic prescribing initiative will have that added to their profiles this year.

The long-term plan is to add information to the site over time, with the reform law pushing the government to post the first patient assessments and measures of clinical care quality by 2015.

Isolate the eight key economic decisions of the Obama presidency: The intervention in the financial sector, the intervention in the auto sector, the intervention in the housing sector, the stimulus package, the health-care bill, financial regulation, and the tax deal…Where there was a market that they considered functional-but-frozen, they worked to unfreeze it.

Intervention into health IT should be added to this list. Nowhere has this administration’s activities to unfreeze private markets been more dramatic than in the health IT products and services sector, especially for electronic health records (EHRs).

When the President was elected, this market was dominated by the vendor-controlled Certification Commission for Health IT (CCHIT). The entry rules were intentionally complex and expensive, safeguarded by an interlocking system of standards organizations and both open and clandestine industry alliances that defended against innovation and new entrants.

A Colorado physician loses his iPhone in the mountains, and the health system he’s affiliated with erases all of its contents remotely so that no one can illicitly access patient data.

A California hospital uses dedicated iPhones to let nurses receive voice messages, text messages and alarms, and they no longer have to cram their pockets with multiple pagers.

A Texas health system gives Blackberries to its transport staff to improve their ability to get radiology equipment where it needs to be. They save hours of time daily, and wear and tear on both equipment and employees.

A New York City hospital has all its administrators bring iPads to leadership meetings and doesn’t allow paper.

Raise the issue of what the "hot technology" in 2011 will be, and Keith Fraidenburg gives a quick answer: "anything associated with meaningful use." Fraidenburg serves as vice president of education and communications for the College of Health Information Management Executives, a member organization of 1,400 hospital CIOs. Its fall forum in 2010, which focused on the federal EHR incentive program, drew nearly 400 of them-an organizational record. In 2011, CHIME members will continue to focus on the key technologies that will enable organizations to apply for meaningful use incentive money (see related story, page 48), including order entry and personal health records, Fraidenburg says. "We will also see more investment in infrastructure."

If anything, 2011 may be remembered as the year of industry focus when it comes to health I.T. At hospitals across the country, CIOs will be leading the charge on upgrading infrastructure and systems, revising documentation and workflow requirements, cajoling vendor cooperation, keeping tabs on system certification, and expanding their efforts to loop in physicians via integrated-or at least highly interfaced-ambulatory EHR ventures. The allure of billions in federal incentive dollars (plus the long-term Medicare payment cuts for providers not in compliance) has clarified these near-term goals for many a hospital. Med schools too are hopping aboard the I.T. bandwagon (see sidebar, page 53).

The Cleveland Clinic has launched a new Center for Personalized Healthcare "for the identification, analysis, adoption and integration of select new services and technologies that will allow for personalized care of patients," according to a news release from the clinic.

Dr. Kathryn Teng, a primary-care physician, has been selected to direct the new center.

New Hampshire has taken one more step toward efforts to connect health-care providers in cyberspace.

The state Department of Health and Human Services has received approval from the federal government of its Health Information Exchange Strategic and Operational Plans for the New Hampshire Health Information Exchange Planning and Implementation Project, a massive information technology project creating an electronic network to exchange health-care information among providers.

At issue is whether the Vermont law restricting such use violates the First Amendment, an argument brought forth by the original plaintiffs in the suit and the winners on appeal in the 2nd U.S. Circuit Court of Appeals in New York. The Supreme Court decision would settle conflicting decisions occurring in the lower courts regarding similar laws in Maine and New Hampshire.

A new federal work group will meet this week to discuss the recommendations in the report by the President’s Council of Advisors on Science and Technology.

HHS' Office of the National Coordinator for Health Information Technology announced Friday the formation of the PCAST Report work group under the purview of its Health IT Policy and Standards committees. The group is scheduled to meet Friday, Jan. 14, from 2 to 4 p.m. ET.

The new group's tasks are "to synthesize and analyze the public comments and input into the PCAST Report relative to implications on current and future ONC work," according to a statement on the ONC's website.

Motion Computing is extending its offering of tablet PCs for healthcare with a new rugged, ultra-light “reader” model.

The new CL900 is suited for clinicians such as respiratory therapists in acute care settings and home health care workers out in the field who often “need a reader more than a full function tablet,” to view patient charts and images. It offers an alternative to devices designed for heavy data entry or to access multiple enterprise applications at the same time, said Mike Stinson, VP of marketing at Motion.

Priced at about $1,000 and weighing about 2 lbs., the CL900 is a thin client tablet running Windows 7 and is powered by Intel’s Atom processor. Options for healthcare use include two cameras that can be used for video conferencing and documentation of care, such as wound care, said Stinson.

In the first four days since its launch, about 4,000 healthcare providers initiated registration for the electronic health record incentive program, according to the Centers for Medicare and Medicaid Services. The agency provided the preliminary count as of Jan. 6.

“We expect that number will continue to increase daily,” said CMS spokesman Joseph Kuchler.

Providers access the CMS registration portal, which became operational Jan. 3, to participate in the Medicare and Medicaid electronic health record (EHR) incentive program.

Eligible professionals who demonstrate meaningful use have the opportunity to receive incentive payments of up to$44,000 from Medicare, or $63,750 from Medicaid. Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars for implementing and meaningfully using certified EHR technology.